LUMBAR DISC DISEASE


Facts:

  1. Accounts for 20-40% of axial low back pain.
    May cause radicular pain with or without nerve compression.
    May occur in absence of x-ray, CT, or MRI findings.
    a. MRI scans may be normal with internal disruption.
    b. Scans may show abnormalities which are not the cause of pain.
  2. Physical examination may or may not be revealing.

Symptoms:

  1. Central low back pain with or without radicular pain.
    Pain worse in evenings than in the mornings.
    Pain may radiate into the hip and buttock areas (pseudoradicular pain or somatic referred pain)
    Pain may radiate below the knee (radicular pain)
    Pain worsened by flexion.
    Patient may have dysesthesia in the distribution of the affected nerve.
  2. Numbness and weakness with large compressive disks.

Diagnosis:

  1. MRI scans are helpful when findings agree with symptoms.
    Provocation discography may be needed to diagnose discogenic pain.
  2. Selective nerve root blocks can help delineate painful nerve roots.

Treatment:

  1. Precision epidural blocks with fluoroscopy (transforaminal usually).
    Fluoroscopically guided caudal blocks with guidable catheter.
    Lysis of epidural adhesions.
    Pulsed radiofrequency treatment of painful nerve roots.
  2. Percutaneous discectomy